Medicare Payment Advisory Commission

Medicare Payment Advisory Commission

TheMedicare Payment Advisory Commission (MedPAC) is an independent congressional agency established to advise the United States Congress on issues affecting the Medicare program. MedPAC was created by the Balanced Budget Act of 1997 and plays a crucial role in shaping Medicare policy by providing analysis and policy advice.

History

MedPAC was established in 1997 as a result of the Balanced Budget Act, which aimed to control Medicare spending and improve the efficiency of the program. The commission was formed by merging two predecessor commissions: the Prospective Payment Assessment Commission (ProPAC) and the Physician Payment Review Commission (PPRC).

Structure and Function

MedPAC is composed of 17 members who are appointed by the Comptroller General of the United States. These members include experts in health care delivery, finance, and policy, as well as representatives of consumers and the elderly. The commission meets publicly to discuss Medicare issues and to develop recommendations for Congress.

MedPAC's primary functions include:

• Analyzing access to care, quality of care, and other issues affecting Medicare beneficiaries.
• Evaluating the effects of Medicare payment policies on providers and beneficiaries.
• Recommending changes to Congress to improve the efficiency and effectiveness of the Medicare program.

Reports and Recommendations

MedPAC submits two main reports to Congress each year, in March and June. These reports contain recommendations on Medicare payment policies, including updates to payment rates for various types of providers, such as hospitals, physicians, and nursing facilities.

The commission's recommendations are not binding, but they are highly influential in shaping Medicare policy. Congress and the Centers for Medicare & Medicaid Services (CMS) often consider MedPAC's advice when making policy decisions.

Impact on Medicare Policy

MedPAC has had a significant impact on Medicare policy over the years. Its recommendations have led to changes in payment systems, such as the implementation of the Prospective Payment System (PPS) for hospitals and the Resource-Based Relative Value Scale (RBRVS) for physician payments.

Challenges and Criticisms

While MedPAC is respected for its expertise and analysis, it has faced criticism for various reasons, including:

• The complexity of its reports, which can be difficult for policymakers and the public to understand.
• The time lag between the commission's recommendations and their implementation.
• The challenge of balancing cost control with maintaining access to high-quality care.

Also see

• Medicare (United States)
• Centers for Medicare & Medicaid Services
• Balanced Budget Act of 1997
• Prospective Payment System
• Resource-Based Relative Value Scale